Patterns of Care in Michigan Emergency Departments as Insurance Coverage Expands

Introduction The MSSS, described elsewhere1, has been in use since 2003 and records ED chief complaint data. As of September 2014, there were 88/136 hospital EDs enrolled in MSSS, capturing 83% of the annual hospital ED visits in Michigan. On April 1, 2014 the Healthy Michigan Plan (HMP) was launched. HMP provides healthcare benefits to low-income adult residents who do not qualify for Medicaid or Medicare. The plan incorporates both federally and state mandated Essential Health Benefits, which includes emergency services. As insurance coverage expands, more people will have the ability to utilize the services of primary care and other providers. In particular, this will affect previously uninsured, low-income populations who are disproportionately affected by chronic disease. We question if access to these services will affect the utilization of emergency services as more people will have a medical home to manage and prevent diseases that may otherwise become an emergent issue. Furthermore, this increased access to health care services will expand care options for urgent but not emergent issues beyond EDs. Conversely, as more people acquire health care benefits the demand for primary care services may exceed the level of access to these services which may lead to an increase of ED utilization for primary care.